Transcript Geriatric Emergencies

Geriatric Emergencies
Topics
 Demographics of the Elderly
 The Aging Process
 Assessment & Management of the
Elderly Patient.
The Elderly...
 Are one of the fastest growing segments
of our population.
 Are persons age 65 or older.
 And their growing number presents a
challenge to all health care providers.
The Facts
 The mean survival rate of older persons is
increasing.
 The birth rate is declining.
 There has been an absence of major wars or
other catastrophes.
 Health care and living standards have
improved significantly since WWII.
 By 2030, 70 million people will be 65 or older.
 Gerontology is the scientific study of the
effects of aging and age-related diseases
on humans.
 Geriatrics is the study and treatment of
diseases of the aged.
Societal Issues
 Elderly persons living alone represent one of
the most impoverished and vulnerable parts of
society.
 Factors include living environments, poverty,
loneliness, social support.
 A deterioration of independence is not
inevitable and not necessarily a function of
aging. It may well be a sign of a heretofore
untreated illness.
Older active adult
Senior volunteer programs
Ethics
 In the course of caring for elderly
patients, ethical concerns frequently
arise. You may be confronted with:
 Multiple decision-makers
 Questions about a patient’s competency
 Advanced directives, or DNRs
Financing & Resources
for Health Care
 Medicare
 Medicaid
 Veterans Administration
VA hospitals provide
a variety of services.
In treating the elderly,
remember that the best
intervention is prevention.
Prevention strategies for the elderly
Meals on wheels provide
1–3 meals a day
Free screening programs for the
elderly
General Pathophysiology,
Assessment, and
Management
Pathophysiology
 The body becomes less efficient with age.
 The elderly often suffer from more than
one illness or disease at a time.
 The existence of multiple chronic
diseases in the elderly often leads to the
use of multiple medications.
Factors that may decrease
compliance in the elderly:
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Limited income
Memory loss
Limited mobility
Sensory impairment
Fear of toxicity
Child-proof containers
Duration of drug therapy
Factors that may increase
compliance in the elderly:
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Good patient-physician communication
Belief that a disease or illness is serious
Drug calendars
Compliance counseling
Blister packaging
Pill boxes
Transportation services to the pharmacy
Ability to read
Clear simple directions
Blister-packs are easier
for the elderly.
Falls
 Present an especially serious problem.
 Represent the leading cause of
accidental death among the elderly.
 May be intrinsic or extrinsic.
 The elderly should be encouraged to
make their homes safe.
Home safety for the elderly
Communications
 Normal physiological changes may
include impaired vision, impaired or loss
of hearing, an altered sense of taste or
smell, and/or a lower sensitivity to
touch.
 Any of these conditions can affect your
ability to communicate with the patient.
Sensory changes in the elderly
Problems with incontinence &
elimination are common in the
elderly.
Factors in Forming a
General Assessment
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Living situation
Level of activity
Network of social support
Level of independence
Medication history
Sleep patterns
Try to distinguish the
patient’s chief complaint
from the primary problem.
Communication
Challenges
Cataracts diminish eyesight
Talk directly to the elderly,
if possible.
Speak into a stethoscope with
the hearing-impaired.
Change in altered mental status can
denote serious underlying problems.
 Only experience and practice will allow you to
distinguish acute from chronic physical
findings in the elderly patient.
 When caring for the elderly:
Encourage patients to express their feelings.
DO NOT trivialize their fears.
Avoid questions.
Confirm what the patient says.
Recall all that you have learned about
communicating with the elderly.
 Assure patients that you understand that they are
adults.
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Changes in the body systems
of the elderly
Common age-related systemic
changes
Common Medical Problems
in the Elderly
Respiratory Disorders
 Pneumonia
 COPD
 Pulmonary
embolism
 Pulmonary edema
 Lung cancer
Respiratory and cardiac problems
can cause dyspnea.
Cardiovascular Disorders
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Angina pectoris
Myocardial infarction
Heart failure
Dysrhythmias
Aortic dissection/aneurysm
Hypertension
Syncope
Neurological Disorders
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Cerebrovascular disease (stroke)
Seizures
Dizziness/vertigo
Parkinson’s disease
Delirium, dementia, Alzheimer’s
Metabolic & Endocrine
Disorders
 Diabetes mellitus
 Thyroid disorders
GI Disorders
 GI hemorrhage
 Upper GI bleed
 Lower GI bleed
 Bowel obstruction
 Mesenteric infarct
Skin Disorders
 Skin diseases
 Pruritus
 Herpes zoster
 Pressure ulcers (decubitus ulcers)
Musculoskeletal Disorders
 Osteoarthritis
 Osteoporosis
Stretching and weight-bearing exercises
help prevent osteoporosis.
Renal Disorders
 Glomerulonephritis
Urinary Disorders
 Urinary tract infections
 Urosepsis
Environmental Emergencies
 Hypothermia
 Hyperthermia
Toxicological Emergencies
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Lidocaine
Beta-blockers
Antihypertensives/diuretics
ACE inhibitors
Digitalis (digoxin, Lanoxin)
Antipsychotropics
Parkinson’s disease medications
Analgesics
Corticosteroids
Substance Abuse
Factors that contribute to substance abuse in the
elderly include:
 Age-related changes
 Employment loss
 Loss of spouse
 Multiple prescriptions
 Malnutrition
 Loneliness
 Moving to an apartment/care home
Behavioral/Psychological
Disorders
Some of the common classifications of
psychological disorders related to age
include:
 Organic brain syndrome
 Depression
 Dependent personality
 Paranoid disorders
Trauma in the Elderly
 Trauma is the leading cause of death in the
elderly.
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Osteoporosis
Reduced cardiac reserve
Decreased respiratory function
Impaired renal function
Decreased elasticity in the peripheral blood vessels
Assessment
 Remember that blood pressure and pulse
readings can be deceptive indicators of
hypoperfusion.
 Leading causes of trauma in the elderly
include falls, motor vehicle crashes, burns,
assault, and syncope.
 Observe the scene for signs of abuse and
neglect.
Serious head injuries sometimes
denote geriatric abuse.
Many states have laws that require
EMS personnel to report suspected cases
of Geriatric abuse and/or neglect.
General Management
When caring for elderly patients,
consider the various changes and
underlying conditions which may affect
your care, such as:
 Cardiovascular considerations
 Respiratory considerations
 Renal considerations
Transport Considerations
Modifications in positioning, immobilization, and
packaging may be necessary in the elderly patient.
Specific Injuries
 Orthopedic injuries
 Burns
 Head and spine injuries
Orthopedic Injuries—Common
Fractures in the Elderly
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Hip or pelvis fractures
Proximal humerus
Distal radius
Proximal tibia
Thoracic and lumbar bodies
Subcapital femoral neck fracture
Burns
People age 60 and older are more likely to
suffer death from burns than any other
group except neonates and infants.
Factors include:
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Slower reaction time
Pre-existing diseases
Age-related skin changes
Immunological/metabolic changes
Reductions in physiological function
Summary
 Demographics of the Elderly
 The Aging Process
 Assessment & Management of the
Elderly Patient